TY - THES A1 - Brüser, Judith T1 - Prüfung der Effektivität eines interdisziplinären psychokardiologischen Behandlungsprogrammes auf die Reduktion von Depressivität, Angst und Panik und die Verbesserung der gesundheitsbezogenen Lebensqualität bei psychisch belasteten kardiologischen Rehabilitanden T1 - Examination of the Effectiveness of an Interdisciplinary Psychocardiological Treatment Programme for the Reduction of Depressivity, Anxiety, and Panic and the Improvement of the Health-Related Quality of Life in Psychologically burdened Cardiological Rehabilitants N2 - In dieser Arbeit wurde geprüft, ob ein leitlinienkonformes psychokardiologisches Behandlungskonzept einer herkömmlichen kardiologischen Behandlung bei psychisch belasteten kardiologischen Rehabilitanden in der Reduktion von Angst, Depression und Panik (primäre Zielkriterien) und einer Verbesserung der gesundheitsbezogenen Lebensqualität (sekundäre Zielparameter) überlegen ist. In der Nebenfragstellung wurden Unterschiede in der Wirksamkeit der Intervention in Abhängigkeit vom Geschlecht explorativ geprüft. Die Fragestellungen wurden mit einem quasiexperimentellen Studiendesign mit sequentiell aufeinanderfolgenden Kohorten untersucht. Die Zielparameter wurden zu Rehabeginn, -ende und 6 Monate nach Entlassung mit validierten Fragebögen (PHQ-9, PHQ-Panik, GAD-7 und MacNew Heart Disease-Fragebogen) erfasst. Die Hauptanalyse ergab einen kleinen signifikanten Intergruppeneffekt für den Zielparameter Depressivität zugunsten der Kontrollgruppe zu Rehaende und in der Katamnese keine signifikanten Unterschiede im Behandlungserfolg beider Studienbedingungen mehr. Die Moderatoranalyse ergab kleine Interaktionseffekte zwischen Intervention und Geschlecht für Angst und die gesundheitsbezogene Lebensqualität zu beiden Folgemess-zeitpunkten. Deskriptiv zeigte sich der Trend, dass Frauen von der Interventionsbedingung schlechter, Männer hingegen besser profitierten. Für die mangelnde Überlegenheit des Interventionsprogrammes kommen vielfältige Aspekte in Frage, die methodisch das sequentiell aufeinanderfolgenden Behandlungsdesign betreffen sowie interventionsbezogen die Ausschöpfung der Therapieressourcen, den Zeitpunkt des Behandlungsbeginns, die Behandlungsdauer, die Berücksichtigung spezifischer Patientenbedürfnisse und auch die Möglichkeit einer ungünstigen Wirkung von Psychotherapie. Ferner war die statistische Power und damit die Aussagekraft der Studie einschränkt. Als Fazit unterliegen noch vielfältige Einflussgrößen gezieltem Forschungsbedarf. N2 - In this study, it was examined whether a guideline-conforming psychocardiological treatment concept is superior to conventional cardiological treatment for psychologically burdened cardiological rehabilitants in the reduction of anxiety, depression, and panic (primary target criteria) and an improvement of the health-related quality of life (secondary target parameters). In the supplementary question, differences in the effectiveness of the intervention depending on gender were exploratively examined. The questions were investigated with a quasiexperimental study design with sequentially consecutive cohorts. Target parameters were assessed at the start and end of rehabilitation and 6 months after discharge using validated questionnaires (PHQ-9, PHQ-Panic, GAD-7, and MacNew Heart Disease Questionnaire). The main analysis showed a small significant intergroup effect for the target parameter depressivity in favour of the control group at the end of rehabilitation and no significant in the treatment success of both study conditions in the catamnesis. The moderator analysis revealed small interaction effects between intervention and gender for anxiety and health-related quality of life at both follow-up measurement points. Descriptively, the trend showed that women benefited less from the intervention condition than men. For the lack of superiority of the intervention programme, various aspects can be considered, which methodically concern the sequentially successive treatment design as well as the exhaustive use of therapy resources, the time of the onset of treatment, the duration of treatment, the consideration of specific patient needs, and also the possibility of an unfavourable effect of psychotherapy. Furthermore, the statistical power and thus the significance of the study was limited. In conclusion, a wide range of influencing variables are still subject to a targeted need for research. KW - Depression KW - Angstsyndrom KW - Lebensqualität KW - Klinische Psychotherapie KW - Herzkrankheit KW - Psychokardiologische Behandlung KW - Angst/Panik KW - gesundheitsbezogene Lebensqualität KW - kardiologische Rehabilitation KW - psychological treatment KW - depression KW - anxiety/panic KW - health-related quality of life KW - cardiac rehabilitation Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-198233 ER - TY - THES A1 - Tönsmann, Johannes T1 - Der Zusammenhang zwischen Lebensqualität bzw. sozialer Unterstützung und dem Bedürfnis nach bzw. der Inanspruchnahme von psychosozialer Unterstützung T1 - The correlation between quality of life and social support on the one hand and the need for and the utilization of psychosocial support on the other hand N2 - Ziel der Arbeit war die Untersuchung eines möglichen Zusammenhangs zwischen Lebensqualität bzw. sozialer Unterstützung und dem Bedürfnis nach bzw. der Inanspruchnahme von psychosozialer Unterstützung bei Tumorpatienten. Die Datenerhebung erfolgte im Rahmen einer deutschlandweiten Multicenterstudie am Studienstandort Würzburg. Eingeschlossen wurden 128 Patienten mit Melanom, gynäkologischen und gastrointestinalen Tumoren. Die Studiendaten wurden mittels Fragebögen erhoben. Hierzu zählten der SF-12-Fragebogen zur Lebensqualität, der SSUK-8-Fragebogen zur sozialen Unterstützung und jeweils ein Fragebogen zum Bedürfnis und zur Inanspruchnahme psychosozialer Unterstützung. Ein Zusammenhang ergab sich zwischen psychischer Lebensqualität und dem Bedürfnis nach psychosozialer Unterstützung. Patienten, die ein Bedürfnis nach psychosozialer Unterstützung äußerten, wiesen eine signifikant niedrigere psychische Lebensqualität auf. Ebenso konnte ein Zusammenhang zwischen der Inanspruchnahme psychosozialer Unterstützung und der Lebensqualität gesehen werden. Patienten, die psychosoziale Unterstützungsangebote in Anspruch genommen hatten, wiesen eine niedrigere körperliche und psychische Lebensqualität auf. Es konnten keine Zusammenhänge zwischen positiver sozialer Unterstützung und dem Bedürfnis nach bzw. der Inanspruchnahme von psychosozialer Unterstützung gesehen werden. N2 - The aim of this paper was to investigate a possible correlation between quality of life and social support and the need for and the utilization of psychosocial support in tumor patients. The data were collected as part of a Germany-wide multicentre study. The data were collected in Würzburg. Included were 128 patients with melanoma, gynecological and gastrointestinal tumors. The study data were collected by questionnaires. These included the SF-12 quality of life questionnaire, the SSUK-8 social support questionnaire and a questionnaire on the need for and the utilization of psychosocial support. There was a correlation between mental quality of life and the need for psychosocial support. Patients who expressed a need for psychosocial support had a significantly lower mental quality of life. We also found a connection between the utilization of psychosocial support and the health-related quality of life. Patients who had used psychosocial support services had a lower physical and mental quality of life. No correlation could be found between positive social support and the need for or the utilization of psychosocial support. KW - Krebs KW - Soziale Unterstützung KW - Lebensqualität KW - Bedürfnis KW - Inanspruchnahme KW - Psychoonkologie KW - Melanom KW - Brustkrebs KW - gastrointestinale Tumore KW - psychosoziale Unterstützung KW - quality of life KW - needs KW - psychosocial support KW - social support KW - utilization Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-183975 ER - TY - JOUR A1 - Schuler, Michael A1 - Murauer, Kathrin A1 - Stangl, Stephanie A1 - Grau, Anna A1 - Gabriel, Katharina A1 - Podger, Lauren A1 - Heuschmann, Peter U. A1 - Faller, Hermann T1 - Pre-post changes in main outcomes of medical rehabilitation in Germany: protocol of a systematic review and meta-analysis of individual participant and aggregated data JF - BMJ Open N2 - Introduction Multidisciplinary, complex rehabilitation interventions are an important part of the treatment of chronic diseases. However, little is known about the effectiveness of routine rehabilitation interventions within the German healthcare system. Due to the nature of the social insurance system in Germany, randomised controlled trials examining the effects of rehabilitation interventions are challenging to implement and scarcely accessible. Consequently, alternative pre-post designs can be employed to assess pre-post effects of medical rehabilitation programmes. We present a protocol of systematic review and meta-analysis methods to assess the pre-post effects of rehabilitation interventions in Germany. Methods and analysis The respective study will be conducted within the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A systematic literature review will be conducted to identify studies reporting the pre-post effects (start of intervention vs end of intervention or later) in German healthcare. Studies investigating the following disease groups will be included: orthopaedics, rheumatology, oncology, pulmonology, cardiology, endocrinology, gastroenterology and psychosomatics. The primary outcomes of interest are physical/mental quality of life, physical functioning and social participation for all disease groups as well as pain (orthopaedic and rheumatologic patients only), blood pressure (cardiac patients only), asthma control (patients with asthma only), dyspnoea (patients with chronic obstructive pulmonary disease only) and depression/anxiety (psychosomatic patients only). We will invite the principal investigators of the identified studies to provide additional individual patient data. We aim to perform the meta-analyses using individual patient data as well as aggregate data. We will examine the effects of both study-level and patient-level moderators by using a meta-regression method. Ethics and dissemination Only studies that have received institutional approval from an ethics committee and present anonymised individual patient data will be included in the meta-analysis. The results will be presented in a peer-reviewed publication and at research conferences. A declaration of no objection by the ethics committee of the University of Würzburg is available (number 20180411 01). KW - medical rehabilitation Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201929 VL - 9 IS - 5 ER - TY - THES A1 - Banduch, Emilia T1 - Soziodemographie, Psychopathologie und Persönlichkeitsfaktoren von „Heavy Usern“ mit anorektischen und bulimischen Essstörungen T1 - Sociodemographic findings, psychopathology and personality features of “heavy users” with anorectic and bulimic eating disorders N2 - Seit Jahren wird trotz der stetigen Modernisierung der medizinischen Versorgungsleistungen ein Anstieg der stationären Einweisungen in den psychiatrischen Kliniken registriert. Dabei nutzt eine kleine Gruppe von Patienten, die sogenannten Heavy User, den Großteil der zur Verfügung stehenden therapeutischen Ressourcen. Diese explorative Studie beschreibt eine Gruppe von erwachsenen, weiblichen Heavy Usern (n=23) mit restriktiver bzw. bulimischer Anorexie oder Bulimie, die mindestens drei stationäre Aufnahmen in einer psychiatrischen Klinik aufwiesen. Als Vergleich dient eine Kontrollgruppe von weiblichen Nicht-Heavy Usern (n=13) mit maximal einem stationären Voraufenthalt. Die Ergebnisse zeigen, dass Heavy User mit der Hauptdiagnose einer Essstörung spezifische soziodemographische, diagnostische und psychopathologische als auch Persönlichkeitsmerkmale aufweisen, die eine rechtzeitige Identifizierung dieser Patientengruppe ermöglichen könnten. Der Heavy Use wird als multifaktorielles Geschehen verdeutlicht und die Notwendigkeit einer frühen Identifikation und Intervention betont. Da die bisherigen Studienergebnisse sehr uneinheitliche Resultate lieferten, sind weitere Untersuchungen dieser Patientengruppe unerlässlich. Die Entwicklung alternativer und individueller Therapieansätze ist angezeigt, um passende Versorgungsangebote für diese therapieresistenten Patienten zu schaffen. N2 - Despite the constant modernization of medical services, an increase of inpatient readmissions in psychiatric services has been noted for years. Patients who show a higher extent of use of inpatient medical treatment are known as heavy users. This explorative study describes a group of female adult heavy users (n=23) with at least three inpatient treatments and compares the findings with a control group of female non-heavy user patients (n=13) with a maximum of one previous admission, both suffering from restrictive or purging-type anorexia nervosa or bulimia nervosa. The results of this paper show that heavy users diagnosed with an eating disorder, appear to have individual sociodemographic, diagnostic and psychopathological characteristics as well as particular personality traits, which seemingly contribute to heavy service use and could be taken into consideration for early identification of this treatment resistant group of patients. The findings stress the heavy use as a multifactorial phenomenon and emphasize the need of early identification and intervention. Since prior studies show inhomogenous results, further qualitative analysis is necessary to develop alternative and individual treatment strategies for heavy users. KW - Anorexia nervosa KW - Heavy user KW - Psychopathologie KW - Bulimia nervosa KW - Essstörungen KW - Soziodemographie Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-156338 ER - TY - JOUR A1 - Mehnert, Anja A1 - Koch, Uwe A1 - Schulz, Holger A1 - Wegscheider, Karl A1 - Weis, Joachim A1 - Faller, Hermann A1 - Keller, Monika A1 - Brähler, Elmar A1 - Härter, Martin T1 - Prevalence of mental disorders, psychosocial distress and need for psychosocial support in cancer patients – study protocol of an epidemiological multi-center study N2 - Background Empirical studies investigating the prevalence of mental disorders and psychological distress in cancer patients have gained increasing importance during recent years, particularly with the objective to develop and implement psychosocial interventions within the cancer care system. Primary purpose of this epidemiological cross-sectional multi-center study is to detect the 4-week-, 12-month-, and lifetime prevalence rates of comorbid mental disorders and to further assess psychological distress and psychosocial support needs in cancer patients across all major tumor entities within the in- and outpatient oncological health care and rehabilitation settings in Germany. Methods/Design In this multicenter, epidemiological cross-sectional study, cancer patients across all major tumor entities will be enrolled from acute care hospitals, outpatient cancer care facilities, and rehabilitation centers in five major study centers in Germany: Freiburg, Hamburg, Heidelberg, Leipzig and Würzburg. A proportional stratified random sample based on the nationwide incidence of all cancer diagnoses in Germany is used. Patients are consecutively recruited in all centers. On the basis of a depression screener (PHQ-9) 50% of the participants that score below the cutoff point of 9 and all patients scoring above are assessed using the Composite International Diagnostic Interview for Oncology (CIDI-O). In addition, all patients complete validated questionnaires measuring emotional distress, information and psychosocial support needs as well as quality of life. Discussion Epidemiological data on the prevalence of mental disorders and distress provide detailed and valid information for the estimation of the demands for the type and extent of psychosocial support interventions. The data will provide information about specific demographic, functional, cancer- and treatment-related risk factors for mental comorbidity and psychosocial distress, specific supportive care needs and use of psychosocial support offers. KW - metaanalysis KW - depression KW - survivors KW - care KW - sample KW - instrument KW - quality-of-life KW - generalized anxiety disorder KW - cooperative-oncology-group KW - decision making Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-153296 VL - 12 IS - 70 ER - TY - THES A1 - Grunz, Jan-Peter T1 - Benefit Finding von Patienten mit Prostatakrebs im Behandlungsverlauf T1 - Benefit finding in patients with prostate cancer during therapy N2 - Bei Prostatakrebspatienten zeigte sich eine niedrige Tendenz zu Benefit Finding am Behandlungsbeginn und drei Monate später (Mt1 = 2,87; SDt1 = 0,96; Mt2 = 2,92; SDt2 = 0,94). Die gesundheitsbezogene Lebensqualität sank dagegen im Verlauf der 12 Wochen nach Therapiebeginn deutlich (Mt1 = 74,06; SDt1 = 18,70; Mt2 = 70,81; SDt2 = 19,19). Benefit Finding und gesundheitsbezogene Lebensqualität korrelierten zu beiden Untersuchungsterminen jeweils schwach negativ miteinander. Der Zusammenhang beider Variablen war jedoch in Regressionsanalysen für den zeitlichen Verlauf über drei Monate nicht reproduzierbar. Zusammenfassend muss deshalb postuliert werden, dass sich Benefit Finding unmittelbar bei Therapiebeginn für Prostatatkrebspatienten nicht als Prädiktor für verbesserte Lebensqualität nach drei Monaten eignet und vice versa. N2 - Patients with prostate cancer showed a low tendency for benefit finding at start of therapy and three months later (Mt1 = 74,06; SDt1 = 18,70; Mt2 = 70,81; SDt2 = 19,19). In contrast quality of life decreased significantly over the course of twelve weeks (Mt1 = 74,06; SDt1 = 18,70; Mt2 = 70,81; SDt2 = 19,19). Consistent with earlier studies that differentiate between the terms 'Meaning Making' (process) and 'Meaning Made' (result) we found slightly negative relationship between benefit finding and quality of life in each measurement. However, after performing regression analysis we were unable to show any correlation between benefit finding at start of therapy and quality of life three months later and vice versa. KW - Sinnsuche KW - Benefit Finding KW - Prostatakarzinom KW - Gesundheitsbezogene Lebensqualität Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-162180 ER - TY - JOUR A1 - Tsiligianni, Ioanna G. A1 - Alma, Harma J. A1 - Kocks, Janwillem W. H. A1 - de Jong, Corina A1 - Jelusic, Danijel A1 - Wittmann, Michael A1 - Schuler, Michael A1 - Schultz, Konrad A1 - Kollen, Boudewijn J. A1 - van der Molen, Thys T1 - Investigating sensitivity, specificity, and area under the curve of the Clinical COPD Questionnaire, COPD Assessment Test, and Modified Medical Research Council scale according to GOLD using St George's Respiratory Questionnaire cutoff 25 (and 20) as reference JF - International Journal of COPD N2 - Background: In the GOLD (Global initiative for chronic Obstructive Lung Disease) strategy document, the Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), or modified Medical Research Council (mMRC) scale are recommended for the assessment of symptoms using the cutoff points of CCQ ≥1, CAT ≥10, and mMRC scale ≥2 to indicate symptomatic patients. The current study investigates the criterion validity of the CCQ, CAT and mMRC scale based on a reference cutoff point of St George’s Respiratory Questionnaire (SGRQ) ≥25, as suggested by GOLD, following sensitivity and specificity analysis. In addition, areas under the curve (AUCs) of the CCQ, CAT, and mMRC scale were compared using two SGRQ cutoff points (≥25 and ≥20). Materials and methods: Two data sets were used: study A, 238 patients from a pulmonary rehabilitation program; and study B, 101 patients from primary care. Receiver-operating characteristic (ROC) curves were used to assess the correspondence between the recommended cutoff points of the questionnaires. Results: Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥25 were: study A, 0.99, 0.43, and 0.96 for CCQ ≥1, 0.92, 0.48, and 0.89 for CAT ≥10, and 0.68, 0.91, and 0.91 for mMRC ≥2; study B, 0.87, 0.77, and 0.9 for CCQ ≥1, 0.76, 0.73, and 0.82 for CAT ≥10, and 0.21, 1, and 0.81 for mMRC ≥2. Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥20 were: study A, 0.99, 0.73, and 0.99 for CCQ ≥1, 0.91, 0.73, and 0.94 for CAT ≥10, and 0.66, 0.95, and 0.94 for mMRC ≥2; study B, 0.8, 0.89, and 0.89 for CCQ ≥1, 0.69, 0.78, and 0.8 for CAT ≥10, and 0.18, 1, and 0.81 for mMRC ≥2. Conclusion: Based on data from these two different samples, this study showed that the suggested cutoff point for the SGRQ (≥25) did not seem to correspond well with the established cutoff points of the CCQ or CAT scales, resulting in low specificity levels. The correspondence with the mMRC scale seemed satisfactory, though not optimal. The SGRQ threshold of ≥20 corresponded slightly better than SGRQ ≥25, recently suggested by GOLD 2015, with the established cutoff points for the CCQ, CAT, and mMRC scale. KW - pulmonary disease KW - chronic obstructive KW - health status Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-165427 VL - 11 ER - TY - JOUR A1 - Lukasczik, Matthias A1 - Wolf, Hans-Dieter A1 - Gerlich, Christian A1 - Küffner, Roland A1 - Vogel, Heiner A1 - Neuderth, Silke T1 - Addressing Work-Related Issues in Medical Rehabilitation: Revision of an Online Information Tool for Healthcare Professionals JF - Rehabilitation Research and Practice N2 - Background. Medical rehabilitation increasingly considers occupational issues as determinants of health and work ability. Information on work-related rehabilitation concepts should therefore be made available to healthcare professionals. Objective. To revise a website providing healthcare professionals in medical rehabilitation facilities with information on work-related concepts in terms of updating existing information and including new topics, based on recommendations from implementation research. Method. The modification process included a questionnaire survey of medical rehabilitation centers (n=28); two workshops with experts from rehabilitation centers, health payers, and research institutions (n=14); the selection of new topics and revision of existing text modules based on expert consensus; and an update of good practice descriptions of work-related measures. Results. Health payers’ requirements, workplace descriptions, and practical implementation aids were added as new topics. The database of good practice examples was extended to 63 descriptions. Information on introductory concepts was rewritten and supplemented by current data. Diagnostic tools were updated by including additional assessments. Conclusions. Recommendations from implementation research such as assessing user needs and including expert knowledge may serve as a useful starting point for the dissemination of information on work-related medical rehabilitation into practice. Web-based information tools such as the website presented here can be quickly adapted to current evidence and changes in medicolegal regulations. KW - medical rehabilitation KW - online tool Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146911 VL - 2016 ER - TY - JOUR A1 - Neuderth, Silke A1 - Schwarz, Betje A1 - Gerlich, Christian A1 - Schuler, Michael A1 - Markus, Miriam A1 - Bethge, Matthias T1 - Work-related medical rehabilitation in patients with musculoskeletal disorders: the protocol of a propensity score matched effectiveness study (EVA-WMR, DRKS00009780) JF - BMC Public Health N2 - Background Musculoskeletal disorders are one of the most important causes of work disability. Various rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. As the effects of conventional medical rehabilitation programs on sickness absence duration were shown to be slight, work-related medical rehabilitation programs have been developed and tested. While such studies proved the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation in well-conducted randomized controlled trials, its effectiveness under real-life conditions has yet to be proved. Methods/Design The cohort study will be performed under real-life conditions with two parallel groups. Participants will receive either a conventional or a work-related medical rehabilitation program. Propensity score matching will be used to identify controls that are comparable to treated work-related medical rehabilitation patients. Over a period of three months, about 18,000 insured patients with permission to undergo a musculoskeletal rehabilitation program will be contacted. Of these, 15,000 will receive a conventional and 3,000 a work-related medical rehabilitation. We expect a participation rate of 40 % at baseline. Patients will be aged 18 to 65 years and have chronic musculoskeletal disorders, usually back pain. The control group will receive a conventional medical rehabilitation program without any explicit focus on work, work ability and return to work in diagnostics and therapy. The intervention group will receive a work-related medical rehabilitation program that in addition to common rehabilitation treatments contains 11 to 25 h of work-related treatment modules. Follow-up data will be assessed three and ten months after patients’ discharge from the rehabilitation center. Additionally, department characteristics will be assessed and administrative data records used. The primary outcomes are sick leave duration, stable return to work and subjective work ability. Secondary outcomes cover several dimensions of health, functioning and coping strategies. Discussion This study will determine the relative effectiveness of a complex, newly implemented work-related rehabilitation strategy for patients with musculoskeletal disorders. KW - propensity score matching KW - work-related medical rehabilitation KW - effectiveness KW - work ability KW - return to work Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-150015 VL - 16 IS - 804 ER - TY - JOUR A1 - Peters, Stefan A1 - Faller, Hermann A1 - Pfeifer, Klaus A1 - Meng, Karin T1 - Experiences of Rehabilitation Professionals with the Implementation of a Back School for Patients with Chronic Low Back Pain: A Qualitative Study JF - Rehabilitation Research and Practice N2 - A standardized curriculum back school (CBS) has been recommended for further dissemination in medical rehabilitation in Germany. However, implementation of self-management education programs into practice is challenging. In low back pain care, individual factors of professionals could be decisive regarding implementation fidelity. The study aim was to explore attitudes and experiences of professionals who conducted the back school. Qualitative interviews were led with 45 rehabilitation professionals. The data were examined using thematic analysis. Three central themes were identified: (a) “back school as a common thread,” (b) “theory versus practice,” and (c) “participation and patient-centeredness.” The CBS and its manual were frequently described positively because they provide structure. However, specified time was mentioned critically and there were heterogeneous perceptions regarding flexibility in conducting the CBS. Theory and practice in the CBS were discussed concerning amount, distribution, and conjunction. Participation and patient-centeredness were mainly mentioned in terms of amount and heterogeneity of participation as well as the demand for competences of professionals. Factors were detected that may either positively or negatively influence the implementation fidelity of self-management education programs. The results are explorative and provide potential explanatory mechanisms for behavior and acceptance of rehabilitation professionals regarding the implementation of biopsychosocial back schools. KW - Rehabilitation Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146053 VL - 2016 IS - 9 ER - TY - JOUR A1 - Musekamp, Gunda A1 - Gerlich, Christian A1 - Ehlebracht-König, Inge A1 - Faller, Hermann A1 - Reusch, Andrea T1 - Evaluation of a self-management patient education program for patients with fibromyalgia syndrome: study protocol of a cluster randomized controlled trial JF - BMC Musculoskeletal Disorders N2 - Background Fibromyalgia syndrome (FMS) is a complex chronic condition that makes high demands on patients’ self-management skills. Thus, patient education is considered an important component of multimodal therapy, although evidence regarding its effectiveness is scarce. The main objective of this study is to assess the effectiveness of an advanced self-management patient education program for patients with FMS as compared to usual care in the context of inpatient rehabilitation. Methods/Design We conducted a multicenter cluster randomized controlled trial in 3 rehabilitation clinics. Clusters are groups of patients with FMS consecutively recruited within one week after admission. Patients of the intervention group receive the advanced multidisciplinary self-management patient education program (considering new knowledge on FMS, with a focus on transfer into everyday life), whereas patients in the control group receive standard patient education programs including information on FMS and coping with pain. A total of 566 patients are assessed at admission, at discharge and after 6 and 12 months, using patient reported questionnaires. Primary outcomes are patients’ disease- and treatment-specific knowledge at discharge and self-management skills after 6 months. Secondary outcomes include satisfaction, attitudes and coping competences, health-promoting behavior, psychological distress, health impairment and participation. Treatment effects between groups are evaluated using multilevel regression analysis adjusting for baseline values. Discussion The study evaluates the effectiveness of a self-management patient education program for patients with FMS in the context of inpatient rehabilitation in a cluster randomized trial. Study results will show whether self-management patient education is beneficial for this group of patients. KW - rheumatology KW - evaluation KW - self-management KW - patient education KW - fibromyalgia syndrome KW - cluster-RCT KW - rehabilitation Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146075 VL - 17 IS - 55 ER - TY - THES A1 - Merwart, Moritz T1 - Die Inanspruchnahme von psychosozialen Unterstützungsangeboten bei Krebskranken - eine geschlechtsspezifische Untersuchung T1 - Utilization of psychosocial interventions amongst cancer patients - a gender specific analysis N2 - Untersuchung der Inanspruchnahme von psychosozialen Unterstützungsangeboten bei Krebspatienten. In einer multizentrischen Studie wurde untersucht, welche Unterstützungsangebote bevorzugt in Anspruch genommen werden und ob es hinsichtlich der Inanspruchnahme einen Geschlechterunterschied gibt. Außerdem wurden diverse andere Prädiktoren untersucht, die einen Einfluss auf die Inanspruchnahme haben können (z.B. Depressivität, psychische Störung, Alter, Bildungsstand). Zur Datenerhebung dienten Selbstbeurteilungsinstrumente in Form von Fragebögen und ein standardisiertes klinisches Interview (CIDI). N2 - Analysis of cancer patients´desire for psychosocial support and identification of patients´sociodemographic and disease related factors (such as gender, age, depression, education) with the utilization of psychosocial interventions. KW - Psychoonkologie KW - Geschlechtsunterschied KW - Krebs KW - Inanspruchnahme KW - Nichtinanspruchnahme KW - Composite international diagnostic interview KW - Psychooncology KW - Cancer KW - Gender difference KW - psychsosocial interventions KW - depression Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-74324 ER - TY - THES A1 - Blässer, Katharina T1 - Psychosoziales Unterstützungsbedürfnis bei Patienten mit maligner Krebsdiagnose ermittelt im Rahmen einer multizentrischen Querschnittsstudie T1 - Psychosocial support needs of patients with malignant cancer diagnosis found in a multicentric cross section study N2 - Ziel der vorliegenden Arbeit ist es darzustellen, wie groß das psychosoziale Unterstützungsbedürfnis von Patienten mit maligner Krebsdiagnose ist und welche multivariablen Zusammenhänge mit diesem Bedürfnis bestehen. Die dazu nötigen Daten wurden mit einem Selbsteinschätzungsfragebogen erhoben, der im Rahmen einer multizentrisch angelegten Querschnittsstudie zum Thema „Prävalenz psychosozialer Belastungen, psychischer Störungen und ihr Behandlungsbedarf bei Tumorpatienten“ in fünf Zentren in Deutschland entwickelt wurde. Die Stichprobe umfasste 386 Patienten im Alter von 18 bis 75 Jahren, die deutsch sprachen und an einer malignen Krebserkrankung litten. Das Unterstützungsbedürfnis der Patienten wurde in Bezug auf geschlechtsspezifische Unterschiede, Alter, Setting und vorhandene psychosoziale Unterstützung durch Freunde und Familie untersucht. Die Ergebnisse decken sich weitgehend mit denen der bisherigen Forschung. So gab ungefähr ein Drittel der Patienten einen Wunsch nach psychosozialer Unterstützung an. Weiterhin gaben Patienten, die sich psychisch belastet fühlten, häufiger einen Wunsch nach psychosozialer Unterstützung an als Patienten, die sich nicht belastet fühlten. Patienten mit bekannter Metastasierung oder unklarem Metastasierungsstatus äußerten im Vergleich zu Patienten mit lokalisierter Tumorerkrankung weniger häufig den Wunsch nach psychosozialer Unterstützung. Patienten, die bereits vor dem Zeitpunkt der Befragung psychosoziale Unterstützung in Anspruch genommen hatten, äußerten signifikant häufiger ein Unterstützungsbedürfnis als Patienten, die bislang keine psychosoziale Unterstützung in Anspruch genommen hatten. Alter, Geschlecht, Setting und vorhandene Unterstützung durch Freunde und Familie zeigten keinen signifikanten Zusammenhang mit dem Unterstützungsbedürfnis. Insgesamt äußert mit ungefähr einem Drittel der Patienten ein großer Anteil des Kollektivs ein Unterstützungsbedürfnis. Dies sollte die Konsequenz nach sich ziehen, dass Patienten, die durch ihre Tumorerkrankung nicht nur körperlich, sondern auch seelisch belastet sind, eine entsprechende Behandlung zuteil oder zumindest angeboten wird. N2 - The present work shows, how big the psychosocial support need of patients with malignant cancer diagnosis is and which multivariable connections with this need exist. The data necessary in addition were raised with a self-assessment questionnaire which was developed within the scope of a multicentric cross section study on the subject „Prevalence of psychosocial suffers, psychic disturbances and her need of treatment with tumour patients“ in five centres in Germany. The study enclosed 386 patients at the age of from 18 to 75 years who spoke German and suffered from a malignant cancer illness. The support need of the patients was examined concerning sex-specific differences, age, setting and available psychosocial support by friends and family. The results coincide extensively with those of the present research. Thus about one third of the patients gave a wish for psychosocial support. Furthermore patients who felt psychically ill, gave a wish for psychosocial support more often han patients who felt not ill. Patients with known metastasis or unclear metastasis expressed in comparison to patients with localised tumour illness less often the wish for psychosocial support. The patients who had taken up psychosocial support already before the time of the questioning expressed significantly more often a support need than patients who had not taken psychosocial support up to now. Age, gender, Setting and available support by friends and family showed no significant connection with the support need. All together a big part of the group expresses with about one third of the patients a support need. This should cause the consequence that to the patients who are not only physical but also emotionally suffering from their tumour illness, a psychooncological treatment is given or at least is offered. KW - Krebsregister KW - Depression KW - Psychoonkologie KW - Lebensqualität KW - psychosoziales Unterstützungsbedürfnis KW - maligne Krebsdiagnose KW - psychoonkologische Versorgung KW - Unterstützungsangebote KW - psychische Belastung KW - psychosocial support need KW - malignant cancer diagnosis KW - psychooncological care KW - support offers KW - psychic suffer Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-76319 ER - TY - THES A1 - Hennig, Kathrin Sabine T1 - Der Zusammenhang von Informationszufriedenheit, Geschlecht und Tumorstadium mit der Lebensqualität von Krebspatienten T1 - The influence of satisfaction with information, gender and cancer stage on quality of life in cancer patients N2 - Krebserkrankungen gehen neben körperlichen Einschränkungen auch mit psychischer Belastung einher. Krebspatienten leiden unter Unsicherheit, Unwissen und Angst. Hierbei kann die Informationsvermittlung eine wichtige Rolle für den Patienten spielen. Die vorliegende Studie untersucht den Zusammenhang von Informationszufriedenheit, Geschlecht und Tumorstadium mit der Lebensqualität von Krebspatienten. Hierzu wurde eine Querschnittsstudie mit Patienten unterschiedlicher Tumorlokalistationen durchgeführt. Zur Datenerhebung dienten Fragebögen zur Selbsteinschätzung der Informationszufriedenheit und der Lebensqualität (EORTC QLQ-C30). N2 - This study investigates the influence of satisfaction with information, gender and cancer stage on quality of life in cancer patients. Therefore cancer patients with different tumor sites were asked in a cross-sectional study design to fill out questionnaires evaluating patients' satisfaction with information and quality of life (EORTC QLQ-C30). KW - Psychoonkologie KW - Krebs KW - Lebensqualität KW - Informationsbedarf KW - Geschlecht KW - Informationszufriedenheit KW - Tumorstadium KW - satisfaction with information KW - cancer stage Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-76875 ER - TY - THES A1 - Wagner, Kathrin T1 - Nachsorgebedürfnis von Patienten mit Adipositas nach stationärer medizinischer Rehabilitation T1 - Obese patients need for aftercare after inpatient medical rehabilitation N2 - Adipositas ist eine chronische, schwer zu behandelnde Erkrankung. Die Therapieerfolge stationärer medizinischer Rehabilitation halten oft nicht lange an. Ziel der Studie ist es, zu klären, ob bei adipösen Patienten nach stationärer medizinischer Rehabilitation überhaupt ein Nachsorgebedürfnis besteht und wenn ja, wie die Nachsorge bezüglich Inhalt und Form gestaltet sein soll, damit sie hilfreich ist. N2 - Obesity is a chronic disease, that is hard to treat. The success of therapy of inpatient medical rehabilitation often doesn´t last for a long time. The purpose of this study is to find out, if obese patients have a need for aftercare after inpatient medical rehabilitation and what kind of aftercare contents and design would be helpful. KW - Fettsucht KW - Nachsorge KW - Rehabilitation KW - Medizinische Rehabilitation KW - Nachsorgebedürfnis KW - aftercare KW - obesity KW - medical rehabilitation KW - patients need Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-75903 ER - TY - THES A1 - Kunert, Mario T1 - Angst und Depression in der primärärztliche Versorgung T1 - Anxiety and depression in the primary care N2 - Die vorliegende Studie untersucht den Einsatz von Kurz-Screening-Instrumenten (bestehend aus dem PHQ-4, mit seinen beiden Untereinheiten dem GAD-2 und dem PHQ-2) hinsichtlich der Tauglichkeit für einen Routineeinsatz in Hausarztpraxen. Gescreent wurde auf das mögliche Vorliegen einer Angst- und/oder depressive Störungen mit anschließender Validitätsprüfung einer kleineren Stichprobe. Hinsichtlich der Validitätsprüfung konnte zwischen den CIDI- und den Screening-Ergebnissen eine gute Übereinstimmung ermittelt werden (prozentuale Über-einstimmung von 80,8% bei einem Cohen-Kappa von 0,62). Insgesamt betrachtet lässt sich mit einem vertretbaren Mehrbedarf an Zeit für nicht-ärztliche Mitarbeiter ein PHQ-4-Screening in einer Hausarztpraxis durchführen. Durch diese Maßnahme können - bei gleichzeitiger Entlastung des Arztes - wichtige Informationen für eine Krankheitserkennung und für eine ggf. notwendige Therapie gewonnen werden. Über einen Routineeinsatz von Kurz-Screenern in der primär-ärztlichen Versorgung sollte nachgedacht werden. N2 - The present study investigates the use of short screening instruments (consisting of the PHQ-4, with its two subunits the GAD-2 and PHQ-2), regarding the suitability for routine use in primary care practices. It was screened for the possible presence of anxiety and / or depressive symptoms with a following validity check on a smaller unit. The accordance between CIDI and the screening-results could be rated as good (accordance percentage of 80.8% with a Cohens kappa of 0.62). The PHQ-4 leads to a need of more non-medical employees(more time needed), but overall is the PHQ-4 a pracitable instrument in the primary care. Through a routine use of short-Screenern in the primary health care should be considered. KW - Angst KW - Depression KW - Screening KW - Hausarzt KW - Primäre Gesundheitsversorgung KW - Composite international diagnostic interview KW - PHQ-4 KW - PHQ KW - Kurzscreener KW - anxiety KW - depression KW - primary care KW - screening KW - PHQ-4 KW - PHQ KW - CIDI Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-74584 ER - TY - THES A1 - Eirich, Elisa T1 - Glutamaterge Kandidatengene in der Nahinfrarotspektroskopie T1 - Gultametergic promoter polymorphisms in near infrared spectroscopy N2 - Kognitive Defizite in Aufgaben, welche die präfrontale Hirnfunktion, wie das Arbeitsgedächtnis und die Wortflüssigkeit, involvieren, gelten als Schlüssel-komponent der Schizophrenie. Dies führte zur „Hypofrontalitätsthese der Schizophrenie“, die allgemein anerkannt ist, obwohl sie sich bislang definitiver molekularer Grundlagen entbehrt. Störungen der glutamatergen Neuro-transmission mögen eine Rolle spielen, jedoch wurden andere Komponenten bisher kaum untersucht. Kürzlich wurde die Promotorregion von NOS-I, die Einfluss auf glutamaterge Neurotransmission nimmt, wiederholt mit Schizophrenie assoziiert. Daher untersuchten wir zwei funktionale Promoter-Polymorphismen des NOS1-Gens hinsichtlich ihres Einflusses auf die präfrontale Hirnfunktion schizophrener Patienten. Einer der beiden Promoter-Polymorphismen (rs41279104), dessen selteneres Allel zu reduzierter Expression des NS1-Transkriptes führt, wurde bereits als Risikovariante für schizophrene Psychosen beschrieben. Es wurden 43 an chronischer Schizophrenie leidende Patienten sowie 44 gesunde Kontrollpersonen für rs41279104 und NOS1 Exon 1f-VNTR genotypisiert und mittel funktioneller Nahinfrarotspektroskopie (fNIRS untersucht, während sie eine Arbeitsgedächtnis- (N-Back-Test) und eine Wortflüssigkeitsaufgabe (VFT) bearbeiteten, die als Indikator für präfrontale Hirnfunktionen etabliert sind. Nach dem Matching hinsichtlich des Genotypes verblieben Verhaltens- und Hirnaktivierungsdaten von 26 Patienten und 28 Kontrollen, die zu rs41279104 und NOS1 ex1f-VNTR in Beziehung gesetzt wurden. Gesunde Kontrollen zeigten eine signifikante Aktivierung großer Areale des lateralen präfrontalen Cortex während beider Aufgaben, wohingegen Aufgaben-assoziierte Veränderungen der cerebralen Oxygenierung bei Patienten signifikant reduziert waren. Schizophrene Patienten bearbeiteten außerdem beide Aufgaben schlechter. Das rs41279104 Risikoallel (Genotyp AA/AG) konnte mit langsamerer Reaktionszeit im 2-Back-Test sowie bei Patienten mit reduzierter rechtshemisphärischer Aktivierung des frontalen Cortex während des VFT in Verbindung gebracht werden. Unsere fNIRS-Daten erweitern vorangegangene Studien, welche eine gestörte präfrontale Hirnfunktion bei Schizophrenie andeuten und lassen darauf schließen, dass eine genetische Variation von NOS1 eine Rolle in dieser kognitiven Dysfunktion spielt, womöglich durch Beeinflussung glutamaterger Neurotransmission. N2 - Cognitive deficits in tasks involving the prefrontal cortex such as working memory or verbal fluency are a key component of schizophrenia. This led to the hypofrontality hypothesis of schizophrenia, which is widely accepted even though molecular underpinnings are elusive. While disturbances of glutamatergic neurotransmission might play a role, other components have rarely been investigated. Recently, the promoter region of nitric oxide (NO) synthase-I (NOS-I, encoded by the gene NOS1), impacting on prefrontal glutamate transmission, has repeatedly been associated with schizophrenia. We have thus tested whether an associated schizophrenia risk variant (rs41279104), leading to reduced expression of the transcript, influences prefrontal brain functioning. 43 patients suffering from chronic schizophrenia and 44 controls were genotyped for NOS1 rs41279104 and investigated by means of functional near-infrared spectroscopy (fNIRS), while completing a working memory task (2-back test) and a verbal fluency test (VFT). After matching for genotype, behavioral and brain activation data of 26 patients and 28 comparable controls were correlated to rs41279104. Healthy controls showed significant activation of large parts of the lateral prefrontal cortex during both tasks, whereas task-related changes in oxygenation were significantly reduced in patients. Schizophrenic patients also performed worse in both tasks. The NOS1 schizophrenia risk genotype rs41279104 AA/AG was associated with slower reaction time in the 2-back task, as well as with reduced right-hemispheric activation of the frontal cortex for the VFT in patients only. Our fNIRS data extend previous studies suggesting disturbed prefrontal functioning in schizophrenia and suggest that genetic variation of NOS1 has a role in cognitive dysfunctioning, probably by mediating glutamatergic tone. KW - Schizophrenie KW - Arbeitsgedächtnis KW - NO-Synthase-I KW - nNOS KW - Promoterpolymorphismen KW - präfrontale Hirnfunktion KW - NIRS KW - NO-Synthase-I KW - nNOS KW - promoter polymorphism KW - prefrontal functioning KW - NIRS Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-73310 ER - TY - THES A1 - Konrad, Sonja Hedwig T1 - Umsetzung von Nachsorgeempfehlungen nach der stationären medizinischen Rehabilitation T1 - Implementation of recommendations for post-rehabilitation support after the in-patient medical rehabilitation N2 - Im Rahmen einer Zeitstichprobe wurden Nachsorgeempfehlungen nach einer stationären medizinischen Rehabilitation hinsichtlich ihrer Art und Häufigkeit untersucht. Darüber hinaus wurden förderliche sowie hinderliche Faktoren zur Umsetzung der Empfehlungen aus der Sicht der Rehabilitanden erarbeitet. N2 - Analysis of a timetable of measures for a long-term treatment after an operation in hospital. Forms and frequency of these measures within the treatment. Beneficial or inapropriate aspects in the implementation of these measures from the point of view of the concerned patient. KW - Nachsorge KW - Medizinische Rehabilitation KW - Empfehlungen KW - Umsetzung KW - Faktoren KW - Implementation KW - recommendations KW - post-rehabilitation support KW - inpatient medical rehabilitation Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-56728 ER - TY - THES A1 - Schneider, Christine Miriam T1 - Lebensqualität und Langzeitfolgen mehr als zwölf Jahre nach der Diagnose Brustkrebs T1 - Quality of life and long-term consequences more than twelve years after the diagnosis of breast cancer N2 - Untersuchung von LQ und Korrelaten der LQ bei Brustkrebslangzeitüberlebenden sowie der physischen wie psychischen Langzeitfolgen einer Brustkrebserkrankung. N2 - QoL of long-term survivors of breast cancer. Long-term impact of the diagnosis of breast cancer. KW - Lebensqualität KW - Brustkrebs KW - Quality of life KW - breast cancer Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-54134 ER - TY - THES A1 - Benhima, Ghadah T1 - Die Konzeptionen der neurotischen, hysterischen und psychasthenischen Persönlichkeiten bei Pierre Janet T1 - The conceptions of neurotic, hysterical and psychasthenical personnalities by Pierre Janet N2 - In dieser Dissertation werden die Begriffe Hysterie und Psychasthenie aus der Hinsicht Pierre Janet, französischen Arztes des 19. Jahrhundert, anhand zahlreicher Fallbeispiele beschrieben. N2 - In this dissertation will be hysteria and psychasthenia discussed in the sense of Pierre Janet, a french physician from the 19th century, through many case studies. KW - Hysterie KW - Psychasthenie KW - Pierre Janet KW - psychasthenia KW - Pierre Janet Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-51424 ER -